超声心动图引导射频消融术用于心脏肿瘤

Echocardiography-Guided Radiofrequency Ablation for Cardiac Tumors

JACC: CardioOncology

影响因子:12.8

分区:医学1区 Top / 心脏和心血管系统1区肿瘤学1区

发表日期:2024 Aug

作者: Junzhe Huang, Changhui Lei, David H Hsi, Minjuan Zheng, Hui Ma, Shengjun Ta, Rui Hu, Chao Han, Wenxia Li, Jing Li, Dong Qu, Fangqi Ruan, Jing Wang, Bo Wang, Xueli Zhao, Jiao Liu, Lina Zhao, Zhe Wang, Jian Yang, Liwen Liu

DOI: 10.1016/j.jaccao.2024.03.008

摘要

心脏肿瘤患者由于临床状态较差，可能面临手术切除的挑战。超声引导经心尖射频消融术（TARFACT）有望提供一种创伤较小的姑息治疗选择。本研究旨在评估TARFACT的安全性和有效性。共纳入5例心脏肿瘤患者（黏液性脂肉瘤、伴炎性细胞浸润的心肌肥厚肿块、纤维组织肿瘤增生、心肌透明细胞肉瘤和心脏横纹肌瘤）。所有患者均接受了TARFACT，并通过心电图、超声成像、生化分析和病理确认进行评估。所有患者的随访中位时间为9（范围4-12）个月。最后随访时，存活的3例患者仍在生存（分别为9、12和12个月），而晚期肿瘤的2例患者分别存活6和13个月。TARFACT后，所有患者的肿瘤体积均显著缩小：平均长度由6.7 ± 2.0 cm降至4.7 ± 1.8 cm（P=0.007）；平均宽度由5.0 ± 2.1 cm降至2.5 ± 0.7 cm（P=0.041）。NYHA功能分类也有所改善：中位数（IQR）由3.0（1.5）降至2.0（1.0）（P=0.038）；超声心动图中的E波峰值由64.4 ± 15.7 cm/s增加至76.6 ± 18.6 cm/s（P=0.008）；血清N-末端脑钠肽前体（NT-pro BNP）水平由中位数（IQR）从115.7（252.1）pg/mL降至55.0（121.6）pg/mL（P=0.043）。TARFACT是一种新颖的心脏肿瘤姑息治疗手段，能减少可达肿瘤并改善临床症状，初步结果显示其具有一定的潜力。（心脏肿瘤介入[射频/激光消融]治疗[CTIH]；NCT02815553）

Abstract

Patients with cardiac tumors may present challenges for surgical resection due to poor clinical condition. Echocardiography-guided transapical radiofrequency ablation for cardiac tumors (TARFACT) potentially offers a less invasive palliative therapy option.This study aimed to evaluate the safety and efficacy of TARFACT.Five patients with cardiac tumors (mucinous liposarcoma, myocardial hypertrophy with inflammatory cell infiltration mass, fibrous tissue tumor hyperplasia, myocardial clear cell sarcoma, and cardiac rhabdomyoma) were included. All patients underwent TARFACT and were assessed with electrocardiogram, echocardiographic imaging, biochemical analysis, and pathological confirmation.The median follow-up for all patients was 9 (range 4-12) months. Three surviving patients were alive at their last follow-up (9, 12, and 12 months, respectively), whereas 2 patients with late-stage tumors survived 6 months and 13 months after TARFACT, respectively. After TARFACT, all patients showed significant reductions in tumor size: the mean length decreased from 6.7 ± 2.0 cm to 4.7 ± 1.8 cm (P = 0.007); and the mean width decreased from 5.0 ± 2.1 cm to 2.5 ± 0.7 cm (P = 0.041). NYHA functional class also improved: median (IQR) decreased from 3.0 (1.5) to 2.0 (1.0) (P = 0.038), Peak E-wave on echocardiography showed a mean increase from 64.4 ± 15.7 cm/s to 76.6 ± 18.6 cm/s (P = 0.008), and NT-pro BNP levels had a median (IQR) reduction from 115.7 (252.1) pg/mL to 55.0 (121.6) pg/mL (P = 0.043).TARFACT is a novel palliative treatment option for cardiac tumors, reducing accessible tumors and improving clinical symptoms in a preliminary group of patients. (Cardiac Tumors Interventional [Radio Frequency/Laser Ablation] Therapy [CTIH]; NCT02815553).